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�11 <br /> CERTIFICATION <br /> The Applicant,Turkey Canon Quarry Inc.,by,,,A,a2 k M O L ;- as P?cs):;,,t= does hereby certify <br /> that LOGAN T OR KATHIE D WARD (structure owners)shall be compensated <br /> for any damage from the proposed mining operation to the above listed structure(s)located within 200 feet of the <br /> proposed affected area described within Exhibit A,of the Reclamation Permit for Vollmer Pit, <br /> File Number M-1983-035. <br /> Signature ofApplic <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br /> under the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado Mined <br /> Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations.Any alteration or modification to <br /> this fornt shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> V, i <br /> Applicant: fi�Q `f t.�'►JOt� �11�AiLQ-� I� Representative Name: KhTet _m_o1 ,_j��,�. <br /> (Please print) (Please print) <br /> Date: OCi( }b��L �1 ?,o�}� Title: V[4 Q 1(..la OS <br /> STATE OF COLORADO ) <br /> ss. <br /> COUNTY OF El PASO ) <br /> The foregoing was acknowledged before me this COA day of � 6 , 2018, by <br /> Lhk-U - as QL(J� �"t,i!�oV of q 'I C' G RN DO &4MAl I�N(11 . <br /> (sigmture of owner or representative) (title) (company naine) <br /> My Commission Expires: MAA A3D <br /> Notary Public Signature <br /> ERIC S HOWARD <br /> Notary Public <br /> State of Colorado <br /> Notary 1D M 20144021884 <br /> M Commission Ez ires.05-30-2022 <br /> Page 2 of 3 <br />